Association of physical activity with physical function and quality of life in people with hip and knee osteoarthritis: longitudinal analysis of a population-based cohort

Dyslipidemia induced inflammation mediated the association between obesity and Osteoarthritis: a population-based study

BACKGROUND

This study aims to evaluate the mediation effect of dyslipidemia induced inflammation on the causal associations between obesity and Osteoarthritis (OA).

METHODS

This cross-sectional study used data from the National Health and Nutrition Examination Survey (1999-2010). The association between general and abdominal obesity (exposure), OA (outcome) and mediators (total cholesterol, high-density lipoprotein, and C-reactive protein) was assessed using multivariate linear and logistic regression models and mediation analysis.

RESULTS

A total of 23,308 participants were enrolled in this study, and 2,180 were diagnosed with OA. Participants with obesity were more likely to have OA (general obesity: OR = 2.508, 95%CI: 1.602, 4.197, P < 0.001; abdominal obesity: OR = 3.814, 95%CI: 3.242, 4.509, P < 0.001) than those without the obesity. High quantile of total cholesterol (OR:1.399; 95%CI:1.235, 1.257; P < 0.001), high-density lipoprotein (OR:1.644; 95%CI:1.443, 1.874; P < 0.001) and C-reactive protein (OR:1.952; 95%CI:1.707, 2.237; P < 0.001) increased the risk of OA when compared to lowest quartile. In the linear regression, the betas varied from 0.668 (95%CI: 0.635, 0.741; P < 0.001) to 0.693 (95%CI: 0.674, 0.712; P < 0.001), suggesting that individual with obesity had higher C-reactive protein levels. Additionally, total cholesterol and high-density lipoprotein were associated with C-reactive protein. Mediation analyses showed that the causal association of obesity with OA risk was mediated by high-density lipoprotein and C-reactive protein, with the mediation proportion ranging from 17.216 to 45.058%. Moreover, high-density lipoprotein to C-reactive protein path acting as serial mediators in the associations between obesity and OA (general obesity: β = 0.012; 95%CI: 0.009-0.014; abdominal obesity: β = 0.011; 95%CI: 0.008-0.014).

CONCLUSION

The association between obesity and OA is partially mediated by systemic inflammation caused by dyslipidemia. Our study suggested anti-lipid therapy may be positive for obese individuals with OA.

Cross-cultural adaptation and validation of the Arabic version of the knee and hip health-related quality of life (Mini-OAKHQOL) questionnaire in male Saudi patients with osteoarthritis: a methodological observational design

Background

Osteoarthritis (OA) is common in Saudi Arabia, has a significant impact on quality of life (QoL), and lacks a specific questionnaire to measure QoL. The primary objective of this study was to translate and cross-culturally adapt the Mini Osteoarthritis Knee and Hip Quality of Life (Mini-OAKHQOL) questionnaire into Arabic and to determine its psychometric properties among OA knee and/or hip patients in Saudi Arabia.

Methods

A methodological observational design was conducted and followed standard guidelines for cross-cultural adaptation of Mini-OAKHQOL into Saudi Arabic. Two hundred and eight primary OA knee and/or hip male participants aged between 45 and 80 years with a mean age of 58.65 ± 13.8 years and a BMI of 29.5 ± 1.2 kg/m2 were included and performed the stages of translation to target Arabic language (forward T1 and T2), synthesized an Arabic draft (T12), then back-translated to English (BT1 and BT2), followed by expert committee review to rectify the deficiencies leading to a prefinal stage involving a pilot test on native Arabic speakers, thereby finalized a final Arabic version. The Arabic Mini-OAKHQOL, Arabic Short Form 12 (SF12), and visual analog scale (VAS) were administered to analyze internal consistency (IC), test-retest reliability at baseline as well as one week later (up to the 10th day). The construct validity was tested using Spearman's rank correlation, and factor analysis was done to establish a five-factor fit model. Homogeneity was determined using principal component analysis (PCA). Floor and ceiling effects calculated in percentages.

Results

The Arabic Mini-OAKHQOL showed an excellent Cronbach's alpha of the overall scale (α = 0.931) for its internal consistency and an excellent intraclass correlation coefficient (ICC) of 0.947 for its retest reliability, with a high response rate of 93.75%. The construct validity of this scale was good with Ar-SF12 and VAS pain. A five-factor model fit was considered acceptable, and factor loading for each item found within the permissible limits confirmed the factorial validity. None of the items, dimensions, or overall scale showed either a floor or ceiling effect.

Conclusion

The adapted and tested Arabic Mini-OAKHQOL is a reliable and valid questionnaire to measure the impact of knee and/or hip OA on quality of life in the Saudi Arabian male OA population to reduce the respondent's burden for use in clinical and prospective studies.

A Longitudinal Decline in Walking Speed Is Linked with Coexisting Hypertension and Arthritis in Community-Dwelling Older Adults

Objective: The aim was to investigate the association between baseline coexistence of hypertension (HTN) and arthritis, HTN alone, or arthritis alone, and their impact on longitudinal physical function measures among community-dwelling older adults over 5 years of follow-up. Methods: Ours was a longitudinal prospective cohort study from the second wave (2010-2011) and third wave (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP). Data for older adults were used. Participants were categorized based on self-reported diagnoses into four groups: coexisting HTN and arthritis, HTN only, arthritis only, or neither. Physical performance measures included walking speed using the 3-Meter Walk Test and the Five Times Sit-to-Stand Test (FTSST). Multiple generalized estimating equations with linear regression analyses were conducted, adjusting for age, sex, race, body mass index (BMI) educational level, pain severity, and baseline use of pain and hypertension medications. Results: Data for 1769 participants were analyzed. Slower walking speed was only associated with coexisting HTN and arthritis (B = -0.43, p < 0.001) after accounting for covariates. The coexisting HTN and arthritis group showed no significant association with FTSST (B = 0.80, p = 0.072) after accounting for covariates. Conclusions: The coexistence of baseline HTN and arthritis in older adults is associated with a gradual decline in only walking speed as a physical performance measure in older adults.

Mid-Term Clinical and Radiological Changes in the Ankle Joint in Varus Knee Osteoarthritis Following Total Knee Arthroplasty

Background/Objectives: In patients with varus knee osteoarthritis, compensatory changes occur in the foot and ankle joints to compensate for the varus deformity of the knee. The aim of the study was to investigate the changes in the ankle of patients whose knee alignment was corrected with total knee arthroplasty (TKA) and to explore the clinical implications of these findings. Methods: In this retrospective observational study, we analyzed 204 knees of 179 patients who had regular follow-ups out of 431 patients who underwent TKA for varus knee osteoarthritis between January 2019 and July 2021. Patient demographics, body mass index, follow-up time, and radiographs were studied. The hip-knee-ankle (HKA) angle, joint line convergence angle (JLCA), talar tilt (TT) angle, ground talar dome (GT) angle, ground tibia plafond (GP) angle, and the American Orthopaedic Foot & Ankle Society (AOFAS) score were assessed preoperatively and at the last follow-up. Results: A total of 204 knees of 179 patients with a mean follow-up time of 32.50 ± 6.68 months were evaluated. It was found that the change in the HKA had a positive effect on the AOFAS score and a negative effect on the TT, GT, and GP angles. While the clinical score improved in 82 patients, it worsened in 8 patients. The age difference between the groups whose AOFAS score improved and worsened was statistically significant. Conclusions: The correction of the varus malalignment in the knee was shown to also improve the compensatory valgus in the foot and ankle over the mid-term, with a statistically significant improvement in the patients' clinical ankle scores.

The Impact of Exercise Prescription Variables on Intervention Outcomes in Musculoskeletal Pain: An Umbrella Review of Systematic Reviews

BACKGROUND

Musculoskeletal pain conditions are the largest contributors to disability and healthcare burden globally. Exercise interventions improve physical function and quality of life in individuals with musculoskeletal pain, yet optimal exercise prescription variables (e.g. duration, frequency, intensity) are unclear.

OBJECTIVE

We aimed to examine evidence gaps, methodological quality and exercise prescription recommendations in systematic reviews of exercise for musculoskeletal pain.

METHODS

In our prospectively registered umbrella review, PubMed, SPORTDiscus, Cochrane Database of Systematic Reviews, EMBASE, and CINAHL were searched from inception to 14 February 2023. Backward citation tracking was performed. We included peer-reviewed, English language, systematic reviews and meta-analyses of randomized controlled trials (RCTs) and controlled clinical trials (CCTs) that compared exercise with conservative treatment, placebo or other exercise interventions in adults with musculoskeletal pain. Data were extracted from the following groups of reviews based on their reporting of exercise prescription data and analysis of the relationship between prescription variables and outcomes: (1) those that did not report any exercise prescription data, (2) those that reported exercise prescription data but did not perform a quantitative analysis and (3) those that performed a quantitative analysis of the relationship between exercise prescription variables and outcomes. Outcome measures were physical function, pain, mental health, adverse effects and adherence to treatment. AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) was used to assess methodological quality.

RESULTS

From 6757 records, 274 systematic reviews were included. 6.6% of reviews did not report any exercise prescription data, and only 10.9% quantitatively analyzed the relationship between prescription variables and the outcome(s). The overall methodological quality was critically low in 85% of reviews.

CONCLUSION

High methodological quality evidence is lacking for optimal exercise training prescription variables in individuals with musculoskeletal pain. To better inform practice and evidence gaps, future systematic reviews should (1) identify optimum exercise prescription variables, for example, via dose-response (network) meta-analysis, (2) perform high-quality reviews per AMSTAR-2 criteria and (3) include outcomes of mental health, adverse events and exercise adherence.

PROSPERO REGISTRATION NUMBER

CRD42021287440 ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021287440 ).

Personalized Physical Activity Programs for the Management of Knee Osteoarthritis in Individuals with Obesity: A Patient-Centered Approach

Physical activity (PA) plays a vital role in knee osteoarthritis (KOA) management. However, engaging individuals with KOA in regular exercise is challenging, especially when they are affected by obesity. The aim of the current review is to elucidate how to increase adherence to exercise in this population. When implementing a PA program with patients with KOA and obesity, a specific multi-step approach can be adopted. In phase I (the baseline assessment), the patients' eligibility for exercise is ascertained and a physical fitness assessment, sarcopenic obesity screening and quantification of the pain experienced are undertaken. Phase II adopts a patient-centered approach in implementing a PA program that combines an active lifestyle (>6000 steps/day) with land- or water-based exercise programs performed over eight to twelve weeks, with a frequency of three to five sessions per week, each lasting 60 min. In phase III, several strategies can be used to increase the patients' adherence to higher levels of PA, including the following: (i) personalizing PA goal-setting and real-time monitoring; (ii) enhancing physical fitness and the management of sarcopenic obesity; (iii) building a sustainable environment and a supportive social network for an active lifestyle; and (iv) reducing pain, which can ameliorate the clinical severity of KOA and help with weight management in this population.

Exosomes derived from mesenchymal stem cells rescue cartilage injury in osteoarthritis through Ferroptosis by GOT1/CCR2 expression

Osteoarthritis is a prevalent joint disease that significantly affects the daily life of the elderly and is one of the primary causes of disability in this population. This study aims to evaluate the potential pro-inflammatory effects and molecular mechanism of Mesenchymal stem cells-derived exosomes (MSC-Exos) in Osteoarthritis. Bilateral ovariectomy was carried out to induce osteoporosis under anesthesia for the mice. MC3T3-E1 cells were induced for 14 days.HE staining, Safranin O staining and Biomechanical parameter analysis were used in this experiment. MSC-Exos improved osteoarthritis in a mouse model by reducing inflammation levels, preventing ferroptosis, and inducing expression of GOT1/CCR2 to regulate ferroptosis. MSC-Exos also promoted cell growth and osteogenic differentiation of bone cells in an in vitro model. Inhibition of GOT1 reduced the effects of MSC-Exos on cell growth and osteogenic differentiation in an osteoarthritis model. MSC-Exos induce Nrf2/HO-1 expression through the GOT1/CCR2 signaling pathway, resulting in the reduction of Ferroptosis. However, inhibition of Nrf2 reduces the effectiveness of MSC-Exos in treating Osteoarthritis.The results of this study suggest that the GOT1/CCR2/Nrf2/HO-1 signaling pathway plays a crucial role in MSC-Exos-mediated reduction of Ferroptosis in macrophages during Osteoarthritis. These findings may provide a potential therapeutic approach for Osteoarthritis and other orthopedic conditions.

Therapeutic exercise interventions in rat models of arthritis

Arthritis is the leading cause of musculoskeletal pain and disability worldwide. Nearly 50% of individuals over the age of 65 have arthritis, which contributes to limited function, articular pain, physical inactivity, and diminished quality of life. Therapeutic exercise is often recommended in clinical settings for patients experiencing arthritic pain, however, there is little practical guidance regarding the use of therapeutic exercise to alleviate arthritic musculoskeletal pain. Rodent models of arthritis allow researchers to control experimental variables, which cannot be done with human participants, providing an opportunity to test therapeutic approaches in preclinical models. This literature review provides a summary of published findings in therapeutic exercise interventions in rat models of arthritis as well as gaps in the existing literature. We reveal that preclinical research in this field has yet to adequately investigate the impact of experimental variables in therapeutic exercise including their modality, intensity, duration, and frequency on joint pathophysiology and pain outcomes.